The ecological footprint of healthcare: awareness, knowledge, and attitudes of medical students and medical residents.

Introduction: Climate change is widely recognized as the greatest global health threat of the twenty-first century, yet the healthcare sector paradoxically contributes around 4-5% of global greenhouse gas emissions. Although health professionals are well positioned to mitigate this impact, sustainability education remains insufficient in medical curricula. This study aimed to assess the awareness, knowledge, and attitudes of medical students and residents in Italy regarding healthcare's ecological footprint, with the goal of identifying gaps in training and informing curricular development. Methods: A cross-sectional survey was conducted between February and June 2024 at the University of Magna Graecia of Catanzaro. A structured, self-administered questionnaire collected socio-demographic data, knowledge of sustainability concepts, concerns about pollution and climate change, attitudes toward education, preferences for single-use versus reusable medical devices, proposed sustainability measures, and perceived barriers. Results: Logistic regression was used to identify predictors of high concern about pollution and climate change, while Poisson regression examined factors influencing a composite knowledge score. In total, 638 participants were enrolled (mean age 26.8 years; 66% female). Concern was high, with 95% reporting worry about the health impacts of climate change and 73% expressing concern about healthcare-related pollution. Knowledge levels varied: while familiarity with the greenhouse effect was nearly universal, 12% had never heard of the ecological footprint and 28% reported self-directed study. Most participants (84%) supported integrating sustainability into both classroom and clinical training, and 89% recognized the responsibility of healthcare professionals to reduce pollution. Multivariable analysis showed that female gender, older age, and enrollment in nursing or residency programs predicted higher concern, while greater climate change concern, valuing sustainability in medical device use, and support for curricular integration were associated with higher knowledge scores. Discussion: Overall, Italian medical students and residents show strong engagement with environmental health, but significant knowledge gaps persist. Integrating structured climate-health and sustainability education into medical training is essential to prepare future healthcare professionals to lead environmentally sustainable practice.